A straightforward case for the Christmas week – Merry Christmas and Happy 2015, by the way!

This young man returned from Gambia 2 weeks ago, and started having high fever for 5 days prior to seeking medical attention. He had been on a missionary trip, helping to build schools and houses in rural villages in Gambia. Whereas he had been offered malaria prophylaxis, he had not been particularly compliant to the weekly mefloquine regimen. His blood film is shown below.

High parasite load (>2.5% parasitemia in low transmission areas or >20% in any setting)

High serum lactate

Hypoglycemia

Metabolic acidosis

Pulmonary oedema

Renal impairment

Treatment with antimalarials for severe malaria include intravenous (IV) artesunate, with rectal artesunate given in areas where IV access is limited, or IV quinine in when artesunate is not available. A second drug (doxycycline, mefloquine, etc.) is generally given to prevent the development of resistance. In most countries where artesunate is available, oral (or rectal) formulations are generally combinations with another anti-malarial drug.